Objective: To evaluate the presence of concurrent bacterial infection in BMT recipients with GVHD and invasive aspergillosis (IA). Methods: We conducted a retrospective review of medical records of BMT recipients with GVHD and IA at our institution from 1996-99. IA was defined using the Mycoses Study Group Criteria. Pertinent data regarding patient demographics, underlying diseases, clinical features, laboratory data, therapy and outcome were reviewed. Results: We identified 88 BMT recipients with GVHD. Eleven (13%) of 88 had IA. All 11 were receiving steroids for GVHD and were on antimicrobial prophylaxis with Trimethoprim/sulfamethoxazole and penicillin. Six (54%) of 11 patients were admitted from the community with features of bacterial pneumonia. Gram stains and cultures of respiratory secretions revealed only gram-negative pathogens. One patient had Enterobacter cloacae (sputum, blood), 1 patient had Klebseilla pneumoniae (sputum, pleural fluid), 2 patients had Pseudomonas aeruginosa and E. cloacae (sputum, BAL) and 2 patients had P. aeruginosa (sputum). Pulmonary aspergillosis and/or disseminated IA was concurrently diagnosed in all 6 patients. All were treated for both bacterial pneumonia and IA. Five patients died from IA within 3 months. Additional 2 patients had nosocomial infection with gram-negative bacilli (1 each with IV catheter-related P. aeruginosa bacteremia, and urinary tract infection-related Escherichia coli bacteremia). Conclusions: Concurrent gram-negative pneumonia occurs with high frequency in BMT recipients with GVHD and pulmonary aspergillosis. Thus, in this group of patients with IA, gram-negative bacilli, like cytomegalovirus may be significant copathogens.
Full conference title:
37th Annual Meeting of the Infectious Diseases Society of America (IDSA), November 18-21.
- IDSA 37th